Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > Rheumatology - * / 1 / 2 > Flashcards

Rheumatology - * / 1 / 2 Flashcards

1
Q

Septic arthritis definition

A

A joint infection caused by bacteria or virus that spreads to the fluid surrounding the joint, needing immediate treatment
Common in adults and children, rare in adults unless immunosuppressed or diabetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Common causes of septic arthritis

A

Staphylococcus aureus
Gonococcus: commonest in young sexually active individuals
Streptococcus
Gram negative bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF septic arthritis

A 
Pre-existing joint disease such as RA
CKD
Immunosuppression
Prosthetic joints
IVDU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSx of septic arthritis

A

Acutely inflamed tender, swollen joint, reduced ROM, systemically unwell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ix septic arthritis

A

Joint aspiration for MC&S. The fluid itself will appear turbid and yellow, resembling pus.
Bloods: high WCC, high ESR/CRP, U&Es, LFTs, glucose
Blood cultures
X-ray of the joint - space widening, subluxation or dislocation, soft tissue swelling
USS - demonstrate effusion and guide aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Rx of septic arthritis

A

IV Abx
Consider washout under GA
PT after infection resolves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of septic arthritis

A

Osteomyelitis
Arthritis
Akylosis fusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

haematogenous vs non-haematogenous osteomyelitis

A

Haem - children. bacteraemia, organisms settle near metaphysis at growing end of long bone
Non - diabetic foot ulcers/pressure sores, DM, PAD. Contigous spread of infection from adjacent soft tissues to the bone or from direct injury/ trauma to the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SSx osteomyelitis

A

Localised swelling or redness of a long bone. Vertebral disease most common in adults
Fever, pain, malaise develop after a few days, limping/ refusing to weight bear Usually a child with preceding hx of trauma or infection (skin respiratory) Infants: pay present with failure to thrive, drowsiness or irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ix osteomalacia

A

Bloods - raised WCC & neutrophils, raised ESR & CRP, blood cultures +ve in 50%, also do U&Es, LFTs, glucose
Images - plain X-ray (may be normal for ~10d), technetium-99 scan, MRI CT to define extent of bone sequestration & cavitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Rx osteomalacia

A

Pain relief by bed rest, splinting and analgesia
IV ABx according to local guidelines
Surgical drainage of mature suboperiosteal abscess with debridement, obliteration of dead space, soft tissue coverage & blood supply restoration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of osteomalacia

A

disseminated infection (septicaemia, cerebral abscess), chronic osteomyelitis, septic arthritis, deformity due to epiphyseal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of chronic osteomyelitis

A

Acute haemorrhagic osteomyelitis, contaminated trauma and open fractures, joint replacement surgery, 1o chronic infection of the bone (brodie’s abscess, TB, syphillitic osteomyelitis, myocotic osteomyelitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PMR definition and demographics

A

Inflammatory condition causing pain and stiffness in shoulders, pelvic girdle and neck.
Older adults >50, F>M, caucasian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SSx of PMR

A

Bilateral shoulder pain that may radiate to the elbow as well as pelvic girdle pain
Worse with movement
Interferes with sleep
Stiffness for at least 45 minutes in the morning
Systemic symptoms: weight loss, fatigue, low grade fever and low mood
Upper arm tenderness
Carpel tunnel syndrome
Pitting oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnosis and Ix of PMR

A

Clinical presentation and response to steroids, plus exclusion of other conditions
Bloods: FBC, U&E, LFTs, Ca, serum protein electrophoresis, CK, rheumatoid factor
Urine dip
ANA, anti-CCP, Bence Jones, CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rx of PMR

A

Prednisolone 10-20mg/d PO - expect a dramatic response within 1week & consider an alternative diagnosis it not
Steroids for >2yrs, but decrease dose slowly
Gastric & bone protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GCA definition

A

Vasculitis of the temporal artery, overlaps with PMR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SSx GCA

A

severe one-sided temporal headache
scalp tenderness - extreme tenderness to touch
Decreased/absent temporal pulse
Jaw claudication
Visual disturbances - amaurosis fugax (comes down like a curtain - sudden transient vision loss - posterior ciliary arteries/ central retinal artery TIA), RAPD
Polymyalgia rheumatica (30%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ix GCA

A

Temporal artery biopsy (note skip lesions can occur)
Bloods - antibodies, raised ESR/CRP, raised ALP & platelets, low Hb
Fundoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Rx GCA

A

high dose steroids ASAP - prednisolone 60mg/d PO
(IV methylprednisolone if eye symptoms)
Typically 2yr course, the complete remission
Reduce dose once symptoms have resolved & increase again if recur
Gastric & bone protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

RF OA

A

obesity, age, occupation, trauma, being female and family history.

23
Q

4 key X-ray changes in OA

A 
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
24
Q

Presentation of OA

A

Joint pain and stiffness (commonly hips, knees, SI joints, DIPs, MCP at base of thumb, wrist, C spine)
Worsened by activity
Leads to deformity, instability and reduced function

25
Q

Rx OA

A

Lifestyle changes - weight loss, PT, OT, orthotics

Paracetamol, topical NSAIDs + PPI, opiates, intra-articular steroid injections, joint replacement

26
Q

What is crystal arthritis

A

Acute mono-arthropathy with severe joint inflammation caused by deposition of monosodium urate crystals

27
Q

Presentation of crystal arthritis

A

MTP of big toe most commonly (foot, ankle, hand, wrist, elbow, knee)
Gouti tophi
Triggered by trauma, surgery, starvation, infection, diuresis, aspirin

28
Q

Causes of crystal arthritis

A

hereditary (young males, overproducers, associated with hyper-ureic nephropathy), or secondary
Overproduction (10%): high dietary purines (protein & red meat), leukaemia, cytotoxic agents (tumour lysis), high RBC turnover (purine breakdown -> urate) e.g. tumour lysis syndrome
Under-excretion (90%): renal failure, alcohol excess, diuretics

29
Q

Ix crystal arthritis

A

Aspirate - polarised joint microscopy shows birefringement needle shaped urate crystals
X-tray - soft tissue swelling / punched out erosions
Bloods - serum urate

30
Q

Rx crystal arthritis

A

Rest, high fluid intake, reduce thiazides, alcohol, red meat, high dose NSAIDs, colchicine if NSAID CI’d, steroids, prevention and lifestyle modifications
Prophylaxis: allopurinol, febuxostat

31
Q

Pseudogout

A

Calcium pyrophosphate deposition
Acute / chronic / OA with CPPD: CPP crystal arthritis, chro
RF: old age, high PTH, haemochomatosis, hypophosphataemia
Ix: +vely birefringent rhomboid shaped crystals
XR: soft tissue Ca deposition
Rx: cool packs, rest, aspiration, intra-articular steroids

Prevention: LT NSAIDs +/- colchicine may prevent acute attacks; methotrexate & hydroxychloroquine have a role in chronic CPPD

32
Q

Features of RA?

A

systemic autoimmune inflammatory condition
Symmetrical polyarthritis (swollen, painful, stiff small joints)
Better on movement, worse in the morning
HLA DR4/DRB1 linked

33
Q

Late signs of RA in the hands and extra-articular signs

A 
Ulnar deviation (MCP), dorsal wrist subluxation, Boutonniere, swan fingers, Z deformity of thumb, foot changes, larger joints can be involved, guttering between MCPs (synovitis)
Rheumatoid nodules, osteporosis, soft tissue problems (CTS, frozen shoulder), palmar erythema, lymphadenopathy, vasuclitis, amyloidosis, Raynauds, splenomegaly, pericardial effusion, CAD, episcleritis, sclerits etc in eyes.
34
Q

Ix RA

A

Bloods: FBC (anaemia of chronic disease), U&E, LFTs, RhF, anti-CCP (gold standard), raised ESR/CRP (proportional to degree of inflammation
Imaging: X-ray (loss of joint space, osteopenia, soft tissue swelling, erosions), US (synovial hypertrophy, increased blood flow), MRI (synovitis), can aspirate joint (neutrophils)
Arthroscopy
28 joint disease activity score.

35
Q

Dx of RA

A 
Requires 4/7
Morning stiffness
>3 joints affected
Hand joint arthritis
Symmetrical arthritis
\+RF
Radiological changes
36
Q

Poor prognostic factors at presentation

A

Large number of joints involved, RF strong +ve, CCP strong +ve, smoking, early erosions, high disability score

37
Q

Rx RA

A

Refer early to a rheumatologist (before irreversible destruction)
Early use of DMARDs (within 3 months) & biological agents
Steroids for flares (rapidly reduce symptoms & inflam - useful for treating flares) IM depot methylprednisolone 80-120mg
Intra-articular steroids have rapid but ST effects
Oral prednisolone 7.5mg/d may control difficult symptoms but SE’s
NSAIDs (good for symptom relief, no effect on disease progression)
Physio & OT (aids & splints)
Surgery (relieve pain, improve function & prevent deformity)
Replacement
Management of cardio and cerebral RF

38
Q

Psoriatic arthritis

A 
10-40% of pts with psoriasis
can present before skin changes
Swollen, red/soft nodules in DIP joints
Nail pitting and onycholysis 
Asymmetrical joint involvement
Sacroiliitis
Anterior uveitis 
Synovitis
X-ray: erosive changes with 'pencil-in-cup' deformity, floating syndesmophytes, DIP erosion, asymmetrical  
Rx: treat psoriasis - NSAIDS, sulfasalazine, methotrexate, ciclosporin, anti-TNF agents also effective
39
Q

Ankylosing spondylitis

A

Chronic inflammatory condition affecting spine and SI joints of unknown aetiology
HLA-B27 association

40
Q

SSx ankylosing spondylitis

A

Male <30
“young man with back pain of inflammatory nature and postural changes”. Gradual onset low back pain, worse at night (trouble sleeping), stiff in the morning (>30 mins), relieved by exercise, radiating to the hip/butt, improves at the end of the day
Spine exam: Schober’s and FABER

41
Q

Features associated with ankylosing spondylitis

A 
The As
Anterior uveitis 
Achilles tendonitis, plantar fasciitis, costochondritis  
Aortic valve incompetence/ regurgitation  
AVN block  
Amyloidosis  
Apical pulmonary fibrosis  
Osteoporosis
42
Q

Ix ankylosing spondylitis

A

MRI – most sensitive and better at detecting earlier disease
X-ray: sacroillitis, “bamboo spine” - calcified anterior longitudinal ligament, vertebrae fuse posteriorly
SPECT-CT (nuclear imaging) - see increased uptake in inflamed joints
Bloods - FBC (normocytic anaemia), raised ESR, CRP, HLA B27+ve

43
Q

Rx ankylosing spondylitis

A

physio and exercise (not rest) for backache -> AS physio specialist 
NSAIDS and PPI cover (usually relieve symptoms in 48h)
OR steroid injections for temporary relief
Anti-TNFa (infliximab, etanercept) (DMARD) if 2x NSAIDs fail (first need to check for HIV, hep B, C, TB)
Can also add Anti-IL-17 & Secukinumab
Surgery - hip replacement to improve pain & mobility, rarely spinal osteotomy
If osteoporosis consider bisphosphonates

44
Q

Pathophysiology of SLE

A

defective apoptosis causes improper sequestration of DNA -> polyclonal B-cell secretion of pathogenic antibodies causing tissue damage via:
Immune complex formation and deposition
Complement activation

45
Q

RF SLE

A

Autoimmune Hx, HLA-B8/DRE, high E2, drugs, Afro-Caribbean genetics
Drugs: isoniazid, hydralazine, procainamide, quinidine, chlorporazmie, phenytoin -> skin and lungs, remission if drugs stopped

46
Q

SSx SLE

A

Relapsing and remitting
Variable presentation and course
Non-specific symptoms: fever, malaise, fatigue, myalgia
Lymphadenopathy, weight loss, alopecia, nail-fold infarcts, non-infective endocarditis, Raynaud’s, migraine, stroke, retinal exudates, episcleritis

47
Q

SLE: SOAP BRAIN MD

A

Serositis
Oral ulcers
Artheritis (>2 peripheral joints)
Photosensitivity
Blood disorders (haemolytic anaemia, leukopenia, lymphopenia, thrombocytopenia)
Renal involvement (GN as antibody/ complement complexes in kidney -> proteinuria)
Anti-nuclear antibodies
Immunological phenomena (dsDNA, SM / antiphospholipid antibody)
Neuro (seizures, psychosis)
Malar/ butterfly rash
Discoid rash

48
Q

Ix SLE

A

FBC (anaemia of chronic disease, autoimmune haemolysis), raised ESR (CRP normal), U&E (raised urea, creatinine)
Antibodies (ANA, anti-dsDNA)
Complement (C3/4 used up, C3b-4b high as they are breakdown products)
Urine – casts, proteinuria

49
Q

Rx SLE

A

Severe flare - IV cyclophosphamide + high-dose prednisolone
Maintenance - NSAIDs + hydroxychloroquine + photoprotection (hydroxychloroquine causes retinopathy so regular vision checks), low dose-steroids may be of value (steroid sparing agents can be used)
2nd line: add methotrexate, azathioprine or Mycophenolate
3rd line: add biologic (Belimumab)
Cutaneous ssx - topical steroids for rashes, sun protection
Lupus nephritis - more intensive immunosuppression with steroids & cyclophospamide, BP control (ACEI), RRT

50
Q

Antiphospholipid syndrome

A

Anti-cardiolipin antibodies, associated with SLE or as a primary disease
Definition: hypercoagulable state due to autoantibodies that increase clotting
Symptoms: CLOT:
Coagulation defects – clots (arterial and venous) -> cerebral, renal and other vessels
Livedo reticularis – rash
Obstetric complications – recurrent miscarriages
Thrombocytopenia
Rx: watch and wait (if asymptomatic)
Thrombosis - lifelong low dose aspirin or warfarin if recurrent thromboses (aim INR 2-3), seek advice in pregnancy
Recurrent miscarriage - aspirin & LMWH during pregnancy

51
Q

Pathophysiology of Raynaud’s phenomenon

A

Peripheral digit ischemia due to intermittent spas of small arteries and arterioles of the hands and feet
Usually precipitated by cold exposure
White (ischaemia) - blue (deoxygenation) - red (reactive hyperaemia)

52
Q

Causes of Raynaud’s

A

Primary/idiopathic Raynaud’s “disease” (almost invariably in women)
Attacks triggered by exposure to cold or stress
Bilateral arm involvement
No underlying cause or ANA; normal inflammatory markers and normal capillaries
-Secondary Raynaud’s “phenomenon” (autoimmune disease associated)
Connective tissue disorders e.g. scleroderma, polyarteritis nodosa, SLE, RA, DM/PM
Cryoglobulinemia, thrombocytosis, cold agglutinin disease, polycythaemia rubra vera, monoclonal gammopathies
Working with vibrating tools
Hypothyroidism
Thoracic outlet obstruction, Buerger’s disease, atheroma
B-blockers

53
Q

Ix Raynaud’s phenomenon

A

anti-RNA, anti-RNP et. exclude other causes of cold, cyanosed hands e.g. pressure on subclavian artery due to cervical rib, artherosclerosis or Buerger’s disease

54
Q

Rx Raynaud’s phenomenon

A

Conservative: wrap up warm, hand warmers, stop smoking (causes vasoconstriction)
Medical: Ca channel blockers (SE: ankle oedema), phosphodiesterase-5-inhibitors (Viagra, sildenafil - also used for pulmonary HTN)
Surgery: sympathectomy

Rheumatology (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions